Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities
Ravi Kalhan,1 David Slade,2 Riju Ray,2 Chad Moretz,3 Guillaume Germain,4 François Laliberté,4 Qin Shen,5 Mei Sheng Duh,6 Sean Dale MacKnight,4 Beth Hahn3 1Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medic...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2021-04-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/umeclidiniumvilanterol-compared-with-fluticasone-propionatesalmeterol--peer-reviewed-fulltext-article-COPD |
| _version_ | 1818675781076779008 |
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| author | Kalhan R Slade D Ray R Moretz C Germain G Laliberté F Shen Q Duh MS MacKnight SD Hahn B |
| author_facet | Kalhan R Slade D Ray R Moretz C Germain G Laliberté F Shen Q Duh MS MacKnight SD Hahn B |
| author_sort | Kalhan R |
| collection | DOAJ |
| description | Ravi Kalhan,1 David Slade,2 Riju Ray,2 Chad Moretz,3 Guillaume Germain,4 François Laliberté,4 Qin Shen,5 Mei Sheng Duh,6 Sean Dale MacKnight,4 Beth Hahn3 1Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 2US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA; 3US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 4Groupe d’Analyse, Ltée, Montréal, QC, Canada; 5US Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA; 6Analysis Group, Inc., Boston, MA, USACorrespondence: Beth HahnUS Value Evidence and Outcomes, GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USATel +1 919-274-0660Email Beth.a.hahn@gsk.comBackground: Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased medical costs and risk of exacerbations. This study compared COPD-related medical costs and exacerbations in high-cost, high-comorbidity patients with COPD receiving initial maintenance treatment (IMT) with umeclidinium/vilanterol (UMEC/VI) versus fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), or tiotropium (TIO).Methods: This retrospective, matched cohort study identified patients from Optum’s de-identified Clinformatics Data Mart database who initiated UMEC/VI, FP/SAL, B/F, or TIO between January 1, 2014 and December 31, 2018 (index date defined as date of the first fill). Eligibility criteria included age ≥ 40 years at index, ≥ 1 pre-index COPD diagnosis, no pre-index asthma diagnosis, 12 months of continuous insurance coverage pre-index, and high pre-index costs (≥ 80th percentile of IMT population) and comorbidities (Quan-Charlson comorbidity index ≥ 3). Propensity score matching was used to control for potential confounders. On-treatment COPD-related medical costs (primary endpoint) and exacerbations were evaluated.Results: Matched cohorts were well balanced on baseline characteristics (UMEC/VI vs FP/SAL: n=1194 each; UMEC/VI vs B/F: n=1441 each; UMEC/VI vs TIO: n=1277 each). Patients receiving UMEC/VI had significantly lower COPD-related medical costs versus FP/SAL (difference: $6587 per patient per year; P=0.048), and numerically lower costs versus B/F and TIO. Patients initiating UMEC/VI had significantly lower risk of COPD-related severe exacerbation versus FP/SAL (hazard ratio [95% CI]: 0.78 [0.62, 0.98]; P=0.032), B/F (0.77 [0.63, 0.95]; P=0.016), and TIO (0.79 [0.64, 0.98]; P=0.028). The rate of COPD-related severe exacerbations was significantly lower with UMEC/VI versus FP/SAL (rate ratio [95% CI]: 0.73 [0.59, 0.91]; P=0.008) and B/F (0.73 [0.59, 0.93]; P=0.012), and numerically lower versus TIO (0.83 [0.68, 1.04]; P=0.080).Conclusion: These findings suggest that high-cost, high-comorbidity patients with COPD receiving UMEC/VI compared with FP/SAL, B/F, and TIO as IMT may have lower medical costs and exacerbation risk.Keywords: COPD, LAMA/LABA, medical costs, comorbidities, severe exacerbations |
| first_indexed | 2024-12-17T08:33:02Z |
| format | Article |
| id | doaj.art-5a8c0d9a253545d48c642c2cee9fe241 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-12-17T08:33:02Z |
| publishDate | 2021-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-5a8c0d9a253545d48c642c2cee9fe2412022-12-21T21:56:32ZengDove Medical PressInternational Journal of COPD1178-20052021-04-01Volume 161149116164200Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and ComorbiditiesKalhan RSlade DRay RMoretz CGermain GLaliberté FShen QDuh MSMacKnight SDHahn BRavi Kalhan,1 David Slade,2 Riju Ray,2 Chad Moretz,3 Guillaume Germain,4 François Laliberté,4 Qin Shen,5 Mei Sheng Duh,6 Sean Dale MacKnight,4 Beth Hahn3 1Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 2US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA; 3US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 4Groupe d’Analyse, Ltée, Montréal, QC, Canada; 5US Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA; 6Analysis Group, Inc., Boston, MA, USACorrespondence: Beth HahnUS Value Evidence and Outcomes, GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USATel +1 919-274-0660Email Beth.a.hahn@gsk.comBackground: Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased medical costs and risk of exacerbations. This study compared COPD-related medical costs and exacerbations in high-cost, high-comorbidity patients with COPD receiving initial maintenance treatment (IMT) with umeclidinium/vilanterol (UMEC/VI) versus fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), or tiotropium (TIO).Methods: This retrospective, matched cohort study identified patients from Optum’s de-identified Clinformatics Data Mart database who initiated UMEC/VI, FP/SAL, B/F, or TIO between January 1, 2014 and December 31, 2018 (index date defined as date of the first fill). Eligibility criteria included age ≥ 40 years at index, ≥ 1 pre-index COPD diagnosis, no pre-index asthma diagnosis, 12 months of continuous insurance coverage pre-index, and high pre-index costs (≥ 80th percentile of IMT population) and comorbidities (Quan-Charlson comorbidity index ≥ 3). Propensity score matching was used to control for potential confounders. On-treatment COPD-related medical costs (primary endpoint) and exacerbations were evaluated.Results: Matched cohorts were well balanced on baseline characteristics (UMEC/VI vs FP/SAL: n=1194 each; UMEC/VI vs B/F: n=1441 each; UMEC/VI vs TIO: n=1277 each). Patients receiving UMEC/VI had significantly lower COPD-related medical costs versus FP/SAL (difference: $6587 per patient per year; P=0.048), and numerically lower costs versus B/F and TIO. Patients initiating UMEC/VI had significantly lower risk of COPD-related severe exacerbation versus FP/SAL (hazard ratio [95% CI]: 0.78 [0.62, 0.98]; P=0.032), B/F (0.77 [0.63, 0.95]; P=0.016), and TIO (0.79 [0.64, 0.98]; P=0.028). The rate of COPD-related severe exacerbations was significantly lower with UMEC/VI versus FP/SAL (rate ratio [95% CI]: 0.73 [0.59, 0.91]; P=0.008) and B/F (0.73 [0.59, 0.93]; P=0.012), and numerically lower versus TIO (0.83 [0.68, 1.04]; P=0.080).Conclusion: These findings suggest that high-cost, high-comorbidity patients with COPD receiving UMEC/VI compared with FP/SAL, B/F, and TIO as IMT may have lower medical costs and exacerbation risk.Keywords: COPD, LAMA/LABA, medical costs, comorbidities, severe exacerbationshttps://www.dovepress.com/umeclidiniumvilanterol-compared-with-fluticasone-propionatesalmeterol--peer-reviewed-fulltext-article-COPDcopdlama/labamedical costscomorbiditiessevere exacerbations |
| spellingShingle | Kalhan R Slade D Ray R Moretz C Germain G Laliberté F Shen Q Duh MS MacKnight SD Hahn B Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities International Journal of COPD copd lama/laba medical costs comorbidities severe exacerbations |
| title | Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities |
| title_full | Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities |
| title_fullStr | Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities |
| title_full_unstemmed | Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities |
| title_short | Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities |
| title_sort | umeclidinium vilanterol compared with fluticasone propionate salmeterol budesonide formoterol and tiotropium as initial maintenance therapy in patients with copd who have high costs and comorbidities |
| topic | copd lama/laba medical costs comorbidities severe exacerbations |
| url | https://www.dovepress.com/umeclidiniumvilanterol-compared-with-fluticasone-propionatesalmeterol--peer-reviewed-fulltext-article-COPD |
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